Notice2024-30719
Medicare Program; Rural Community Hospital Disemonstration Program: Solicitation of Additional Participants
Primary source
Metadata and text below are from the Federal Register, a public-domain U.S. government work. Always verify the official published version before relying on it for any legal matter.
Published
December 26, 2024
Issuing agencies
Health and Human Services DepartmentCenters for Medicare & Medicaid Services
Abstract
This notice announces a solicitation for up to 10 additional eligible hospitals to participate in the Rural Community Hospital Demonstration program, to run through June 30, 2028.
Full Text
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<title>Federal Register, Volume 89 Issue 247 (Thursday, December 26, 2024)</title>
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[Federal Register Volume 89, Number 247 (Thursday, December 26, 2024)]
[Notices]
[Pages 105049-105050]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2024-30719]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[CMS-5051-N2]
Medicare Program; Rural Community Hospital Disemonstration
Program: Solicitation of Additional Participants
AGENCY: Centers for Medicare & Medicaid Services (CMS), Department of
Health and Human Services (HHS).
ACTION: Notice.
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SUMMARY: This notice announces a solicitation for up to 10 additional
eligible hospitals to participate in the Rural Community Hospital
Demonstration program, to run through June 30, 2028.
DATES: To be assured consideration, applications must be received at
the address provided below by 11:59 p.m. Eastern Standard Time (E.S.T.)
on March 1, 2025.
ADDRESSES: Please email completed applications to the following email
address: <a href="/cdn-cgi/l/email-protection#2371606b67464e4c63404e500d4b4b500d444c55"><span class="__cf_email__" data-cfemail="81d3c2c9c5e4eceec1e2ecf2afe9e9f2afe6eef7">[email protected]</span></a>.
FOR FURTHER INFORMATION CONTACT: Alexis Lilly at 410-786-3501 or by
email at <a href="/cdn-cgi/l/email-protection#b1d0ddd4c9d8c29fddd8ddddc8f1d2dcc29fd9d9c29fd6dec7"><span class="__cf_email__" data-cfemail="7f1e131a07160c5113161313063f1c120c5117170c51181009">[email protected]</span></a>.
SUPPLEMENTARY INFORMATION:
I. Background
Section 410A(a) of the Medicare Prescription Drug, Improvement and
Modernization Act of 2003 (Public Law (Pub. L. 108-173) required the
Secretary to establish a demonstration program to test the feasibility
and advisability of establishing cost-based reimbursement for ``rural
community hospitals'' to furnish covered inpatient hospital services to
Medicare beneficiaries. The demonstration pays rural community
hospitals for such services under a cost-based methodology for Medicare
payment purposes for covered inpatient hospital services furnished to
Medicare beneficiaries. A rural community hospital, as defined in
section 410A(f)(1) of Public Law 108-173, is a hospital that--
<bullet> Is located in a rural area (as defined in section
1886(d)(2)(D) of the Social Security Act (the Act)) or is treated as
being so located pursuant to section 1886(d)(8)(E) of the Act;
<bullet> Has fewer than 51 acute care inpatient beds (excluding
beds in a distinct psychiatric or rehabilitation unit of the hospital)
as reported in its most recent cost report;
<bullet> Provides 24-hour emergency care services; and
<bullet> Is not designated or eligible for designation as a
critical access hospital under section 1820 of the Act.
The demonstration is designed to test the feasibility and
advisability of reasonable cost reimbursement for inpatient services to
small rural hospitals. The demonstration is aimed at increasing the
capability of the selected rural hospitals to meet the needs of their
service areas.
We began the demonstration in 2004 for the initial 5-year period
mandated under section 410A of Public Law 108-173. The demonstration
has been extended three times, each time for an additional 5-year
period--first, by sections 3123 and 10313 of the Affordable Care Act
(Pub. L. 111-148); then by section 15003 of the 21st Century Cures Act
(Pub. L. 114-255), and again by section 128 of the Consolidated
Appropriations Act of 2021 (Pub. L. 116-260). The current 5-year period
of participation, mandated by Public Law 116-260, ends June 30, 2028.
As part of our broader rural strategy initiative and recognizing
the health care challenges facing rural communities, we are conducting
a new solicitation to select 10 additional qualifying hospitals to
participate in the Rural Community Hospital Demonstration approving
such hospitals on a rolling basis beginning May 1, 2025 through June
30, 2028. Please note that, although previous agreements ran for 5-year
periods, agreements under this provision will run only until June 30,
2028. Given the upcoming statutory termination of the model, we are
aligning performance dates for the selected hospitals with the last
performance day for the last currently participating hospital in this
performance cycle.
Section 410A(a)(4) of Public Law 108-173 specified that the
Secretary was to select for participation from among the applicants in
rural areas of States that the Secretary identified as having low
population densities. Therefore, we will only accept applications to
this solicitation from hospitals in the 20 least densely populated
States, according to data for 2020 from the U.S. Census Bureau. These
States are: Alaska, Arizona, Arkansas, Colorado, Idaho, Iowa, Kansas,
Maine, Mississippi, Montana, Nebraska, Nevada, New Mexico, North
Dakota, Oklahoma, Oregon, South Dakota, Utah, Vermont, and Wyoming. We
will not accept applications from hospitals located in other States or
in the US territories.\1\ The statute states that no more than 30 rural
community hospitals can participate. Twenty hospitals are currently
participating in the demonstration program as of November 1, 2024;
therefore, up to 10 additional hospitals may be selected to be able to
begin participation in the demonstration in 2025.
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\1\ See the United States Census Bureau: Historical Population
Density Data (1910-2020) available at: <a href="https://www.census.gov/data/tables/time-series/dec/density-data-text.html">https://www.census.gov/data/tables/time-series/dec/density-data-text.html</a>.
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II. Provisions of the Notice
This notice announces the solicitation for up to 10 additional
hospitals to participate in the Rural Community Hospital Demonstration
Program. Hospitals that enter the demonstration under this solicitation
will be able to participate from May 1, 2025 through June 30, 2028
A. Demonstration Payment Methodology
Hospitals selected for the demonstration will be paid the
reasonable costs of providing covered inpatient hospital services, with
the exclusion of services furnished in a psychiatric or rehabilitation
unit that is a distinct part of the hospital, using the following
rules. For discharges occurring--
<bullet> In the first cost report period upon the hospital's
participation in the demonstration, reasonable costs for covered
inpatient services; and
<bullet> During the second or subsequent cost reporting period, the
lesser of their reasonable costs or a target amount. The target amount
in the second cost reporting period is defined as the reasonable costs
of providing covered inpatient hospital services in the first cost
reporting period, increased by the inpatient prospective payment system
update factor (as defined in section 1886(b)(3)(B) of the Act) for that
particular cost reporting period. The target amount in subsequent cost
reporting periods is defined as the preceding cost reporting period's
target amount increased by the hospital inpatient prospective payment
system (IPPS) update factor for that particular cost reporting period.
Covered inpatient hospital services means inpatient hospital
services (as defined in section 1861(b) of the Act) and includes
extended care services furnished under an agreement under section 1883
of the Act (also known as ``swing beds'').
Section 410A of Public Law 108-173 requires that, in conducting the
demonstration program under this section, the Secretary shall ensure
that the aggregate payments made by the
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Secretary do not exceed the amount which the Secretary would have paid
if the demonstration program under this section was not implemented. To
achieve budget neutrality for this demonstration program in fiscal
years (FYs) since 2004, we have adjusted the national IPPS rates by an
amount sufficient to offset the added costs of this demonstration
program. We will present an estimate of the amount to offset additional
costs due to the demonstration program in FY 2026, including the costs
of additional rural community hospitals, in the FY 2026 IPPS/long-term
care hospital (LTCH) PPS proposed rule.
B. Participation in the Demonstration
To participate in the demonstration, a hospital must be located in
one of the identified States with low-population density and meet the
criteria for a rural community hospital. Eligible hospitals that desire
to participate in the demonstration must properly submit a timely
application. Only applications that are received by the deadline
specified in the DATES section of this notice will be considered
``timely'' and reviewed by the technical panel. Information about the
demonstration and details on how to apply can be found on the CMS
website: <a href="https://www.cms.gov/priorities/innovation/innovation-models/rural-community-hospital">https://www.cms.gov/priorities/innovation/innovation-models/rural-community-hospital</a>.
III. Collection of Information Requirements
The information collection requirements contained in this notice
are subject to the Paperwork Reduction Act of 1995. As discussed in
section II.B. of this notice, a hospital must submit the required
information listed on the cover sheet of the CMS Medicare Waiver
Demonstration Application to receive consideration by the technical
review panel. The burden associated is the time and effort necessary to
complete the Medicare Waiver Application and submit the information to
CMS and is associated with OMB control number 0938-0880.
The Administrator of the Centers for Medicare & Medicaid Services
(CMS), Chiquita Brooks-LaSure, having reviewed and approved this
document, authorizes Chyana Woodyard, who is the Federal Register
Liaison, to electronically sign this document for purposes of
publication in the Federal Register.
Chyana Woodyard,
Federal Register Liaison, Centers for Medicare & Medicaid Services.
[FR Doc. 2024-30719 Filed 12-20-24; 4:15 pm]
BILLING CODE 4120-01-P
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